E

x
a
m

4

-

H
i
g
h

R
i
s
k

B
i
r
t
h
s

a
n
d

O
b
s
t
e
t
r
i
c

E
m
e
r
g
e
n
c
i
e
s


L
o
w
d
e
r
m
i
l
k

C
h

3
3



1

Exam 4 - High Risk Births and Obstetric Emergencies
Lowdermilk Ch 33
OB-106 V NCLEX-RN REVIEW - OB - Part 5 of 6: Newborn/High-
Risk Newborn (38 min.)
Discuss the role of the partner in assisting the patient with a dysfunctional labor
pattern.

cesarean birth - nursing care for the baby and patient post op. assessments and NIC.

Discuss the diagnosis of polyhydramnios and/or oligohydramnios and the patients
outcome for a successful pregnancy.

Discuss the early symptoms of preterm labor

Explain the benefits of tocolytic agents used for pre-term labor.

Discuss the methods used for induction of labor.

Care for a laboring patient receiving augmentation of labor.

Outline the fetal and maternal risks associated with post-term pregnancy.

Discuss the nurses role for a laboring patient who experienced an obstetrical
emergency (prolapsed cord, shoulder dystocia, abruption, uterine rupture).

Identify selected dysfunctional labor patterns and discuss NANDA nursing diagnoses
for a patient experiencing a dysfunctional labor pattern.

1. Discuss the nursing strategies of the woman experiencing a dysfunctional labor
pattern.

2. Identify the common fetal malpositions and malpresentations. Discuss the
assessment data relative to confirming the fetal position.

3. Discuss the maternal and fetal implications when a diagnosis of oligohydramnios
or polyhydramnios has been confirmed. Identify the contributing causes of both
of these abnormal volumes of amniotic fluid.

4. Describe maternal and fetal risks associated with preterm birth.

5. Define premature rupture of membranes and identify nursing care strategies.


E
x
a
m

4

-

H
i
g
h

R
i
s
k

B
i
r
t
h
s

a
n
d

O
b
s
t
e
t
r
i
c

E
m
e
r
g
e
n
c
i
e
s


L
o
w
d
e
r
m
i
l
k

C
h

3
3



2

6. Discuss the use of tocolytics and antenatal glucocorticoids in preterm labor
prevention.

7. Identify appropriate NANDA nursing diagnoses for the high risk woman
experiencing preterm labor.

- Determine a NOC-based outcome from each nursing diagnosis.

- Identify a NIC-based intervention to accompany each nursing diagnosis.

8. Describe the nursing management for the induction and augmentation of labor,
forceps-assisted birth, vacuum-assisted birth, cesarean birth, and vaginal birth
after a cesarean birth.

9. Identify methods that provide the effective emotional support to the woman having an
obstetrical procedure.

10. Discuss the utilization of the nursing process as it relates to the collaborative care for
the woman having a cesarean birth.

12. Describe the care management of a woman experiencing a post term pregnancy.

13. Discuss obstetric emergencies and their appropriate management.

14. Identify the risks to mother and fetus of a prolapsed umbilical cord and outline
nursing interventions.


Dysfunctional Labor Pattern
A. A & P of Normal Labor Process
B. Health Promotion Strategies
1. Risk Factors
C. Patterns
1. Hypertonic labor
2. Hypotonic labor
3. Precipitate labor
D. Application of the Nursing Process
1. Assessment
a. data collection of labor patterns from monitor strip
b. manual palpation of uterine activity
c. progress in labor
2. Analysis/Nursing Diagnosis/NANDA
a. risk for infection
b. pain
c. deficient knowledge of labor

E
x
a
m

4

-

H
i
g
h

R
i
s
k

B
i
r
t
h
s

a
n
d

O
b
s
t
e
t
r
i
c

E
m
e
r
g
e
n
c
i
e
s


L
o
w
d
e
r
m
i
l
k

C
h

3
3



3

d. fatigue
e. impaired gas exchange
f. anxiety
3. Planning/NOC Outcomes/Proposed NIC Interventions
4. Implementation/NIC-Based Outcomes
a. physical
b. psychosocial
c. educational
5. Evaluation
a. critical thinking
b. professional standards of practice
c. evidence-based practice

II. Fetal Malpresentation and Malposition
A. Breech
1. classifications
2. contributing factors (most common)
3. maternal risks
4. fetal risks
5. medical management
a. external cephalic version
6. application of the nursing process
7. professional standards of practice
a. caregiver accountability
B. Shoulder Presentation
1. types
2. common contributing factors
3. maternal risks
4. fetal risks
5. application of the nursing process
C. Face Presentation/Brow
D. Malpositions
1. application of the nursing process

III. Amniotic Fluid Abnormalities
A. Polyhydramnios
1. definition
2. secondary prevention - early detection
3. fetal concerns
4. maternal effects
5. medical management
6. nursing considerations
B. Oligohydramnios
1. definition
2. contributing causes
3. perinatal outcomes

E
x
a
m

4

-

H
i
g
h

R
i
s
k

B
i
r
t
h
s

a
n
d

O
b
s
t
e
t
r
i
c

E
m
e
r
g
e
n
c
i
e
s


L
o
w
d
e
r
m
i
l
k

C
h

3
3



4

4. medical management
5. nursing considerations

IV. Preterm Labor and Premature Rupture of Membranes
A. Definition
B. Incidence
C. Patient Education
D. Clinical Presentation - Risk Factors
E. Tocolytic Agents
F. Complications of Preterm Labor
G. Management
H. Nursing Care

V. The High Risk Woman Experiencing Preterm Labor and the Nursing
Process
A. Health Promotion
1. Primary
2. Secondary
3. Tertiary Prevention
B. Health Promotion Strategies
C. Professional Standards of Practice

VI. Utilization of Nursing Process as it Relates to Preterm Labor
A. Assessment
1. Gordons functional health patterns
2. Collaborative data (diagnostic tests)
B. Analysis/Nursing Diagnosis
1. Anticipatory grieving
2. Anxiety
3. Deficient diversional activity
4. Sleep pattern disturbance
5. Impaired physical mobility
6. Risk for injury - fetal
7. Risk for powerlessness
C. Planning/NOC-Based Outcomes
1. Coping
2. Anxiety reduction
3. Leisure participation
4. Rest
5. Body positioning: self-initiated
6. Fetal status - intrapartum
7. Health beliefs - perceived control
D. Implementation/NIC-Based Interventions
1. Coping enhancement - caregiver support
2. Active listening
3. Recreation therapy

E
x
a
m

4

-

H
i
g
h

R
i
s
k

B
i
r
t
h
s

a
n
d

O
b
s
t
e
t
r
i
c

E
m
e
r
g
e
n
c
i
e
s


L
o
w
d
e
r
m
i
l
k

C
h

3
3



5

4. Energy management - sleep enhancement
5. Exercise therapy
6. Electronic fetal monitoring
7. Decision-making support
E. Evaluation of Outcome Achievement

VII. Interventions of Labor
A. Labor Induction
1. Indications
2. Clinical evaluation
3. Methods
a. Cervical Ripening
1) purpose
2) nursing responsibilities
b. IV medication oxytocin
1) standards of care
2) nursing responsibilities
3) patient teaching
c. Amniotomy
1) nursing responsibilities
B. Augmentation of Labor
1. Reason
2. Methods
3. Nursing interventions
C. Forceps-Assisted Birth
1. Maternal indications
2. Fetal indications
3. Nursing interventions
D. Vacuum-Assisted Births
1. Indications
2. Prerequisites
3. Risks to newborn
4. Nursing interventions
E. Cesarean Birth
1. Incidence
2. Indications
3. Surgical techniques
4. Complications and risks
5. Anesthesia
6. Prenatal preparation
7. Pre- and post-operative care
8. Postpartum care
9. Ethical considerations

VIII. Vaginal Birth After Cesarean
A. Indications

E
x
a
m

4

-

H
i
g
h

R
i
s
k

B
i
r
t
h
s

a
n
d

O
b
s
t
e
t
r
i
c

E
m
e
r
g
e
n
c
i
e
s


L
o
w
d
e
r
m
i
l
k

C
h

3
3



6

B. Prenatal Education
C. Nursing Considerations

IX. Post Term Pregnancy
A. Definition
B. Incidence
C. Clinical Manifestations
D. Maternal and Fetal Risks
E. Car Management
F. Home Care: Patient Teaching
G. Emotional Support

X. Obstetric Emergencies
A. Uterine Rupture
1. etiologic factors
2. clinical manifestations
B. Amniotic Fluid Embolism
1. Etiologic factors
2. Clinical manifestations
3. Emotional support to family
C. Prolapsed Umbilical Cord
1. Maternal risks
2. Fetal risks
3. Incidence
4. Clinical assessment
5. Emergency nursing intervention

D. Placental Abruption
1. Etiological factors
2. Clinical assessment
3. Emergency nursing interventions

E. Shoulder Dystocia
1. Etiological factors
2. Clinical manifestations
3. Fetal risks
4. Emergency nursing interventions